Differences in sources of lead exposure for Hispanic and Non-Hispanic childhood

lead poisoning cases in California

Amy G. Cantor, MHS1, Lynn Goldman, MD, MPH2, Joseph G. Courtney, PhD3, and David Kattari3. (1) University of Texas Health Science Center, San Antonio (2) Johns Hopkins University School of Public Health (3) Childhood Lead Poisoning

Prevention Branch, California Department of Health Services

Lead Poisoning: A Brief History

• Lead recognized as a threat to human health since 1920’s

• Early cases linked to lead paint — acute exposures

• Scientific evidence and litigation → new requirements for paint, lead screening, housing regulations

Why are cases of lead poisoning still being documented?

Childhood Lead Poisoning in California

• 1999-2000: A disproportionate number of cases are Hispanic

• Minorities are at a higher risk

• Differences in exposure sources for these groups have not been thoroughly assessed

Research Questions

• Are there ethnic disparities in lead exposure?

• Are certain identifiable risk factors linked to cultural practices?

Study Design

• RASSCLE: Response And Surveillance System for Childhood Lead Exposures

• Specific risks for childhood lead poisoning

• Folk remedies and other culturally related sources of lead exposure (imported candies and pottery)

• Ethnic differences in identified exposure sources

• Evaluation based on ethnic group categories consistent with US census data

Study Population

• Data source – all cases reported from 1999 & 2000

• Case definition

• California law – report BLL > 25 ug/dL

• Most children reported if BLL > 10 ug/dL

Sources of Lead Exposure

Traditional – Lead-based paint

chips– Old window glaze – Soil, dust, and debris

from building renovation

– Household dust

Non-traditional– Foreign

manufactured items– Leaded pots and

pans– Cosmetics– Traditional

medicines– Ceramics– Leaded crystal

Paint: A Modern Problem

Why are Children at Risk?

• Lower body weight

• Lower overall tolerance to toxic substances

• Increased hand to mouth activity

Chronic Effects

• Central nervous system damage

• Permanent learning impairment

• Attention span, growth, behavior deficits

Hispanic Children – at Increased Risk?

• Poorly maintained, older housing

• Deteriorating paint

• Lead dust particles in soil

• High lead levels in urban areas

• Limited access to health care

• Culturally linked exposures

Mexican Candy

Ceramics and Home Remedies

Ethnic Disparities in Lead Exposure

• 1621 cases between 1999-2000

• 81.3% of cases (n = 1317) are Hispanic

• Cultural Sources:– Identified in 22% of all cases– Only source of exposure in 5% of cases (n = 81)

• 43% of California’s population < 21 years old are Hispanic

Paint-related exposures predominateamong cases of lead poisoning

for children in California

“Paint-related” and “culturally linked” sources of lead poisoning for Hispanic

and Non-Hispanic casesRelative % of cases identified with a source of lead poisoning

0

10

20

30

40

50

60

70

80

90

Paint/Dus t/Soil Hom e Rem edy Pottery

Exposure Source

Re

lati

ve

% o

f C

as

es

Hispanic Non-Hispanic

Lead poisoning in 2003: Are we protecting our children?

“Lead exposures to Mexican candy, home remedies and pottery are culturally linked sources that are causing great harm to Hispanic children in California”

- Amy Cantor, New York Times letter to the editor, October 6, 2003

Future Directions

• Culturally sensitive prevention strategies

• Lead screening

• Policy

Acknowledgments

• Joseph Courtney and David Kattari, California Childhood Lead Poisoning Prevention Branch

• Lynn Goldman, Johns Hopkins University, Bloomberg School of Public Health